Thursday, September 24, 2015


I just had a very long phone conversation with a friend trying to figure out what to do with a mutual patient.  She is the patient's attending, and I the consultant, and we were stuck deciding between two similarly bad alternatives.  Pick option A, and the patient might die.  Pick option B, and the patient might still die.

We discussed whether there were other options for treatment (none that we could see).  We debated the pros and cons of each option (essentially equal).  We tried to think of similar cases we had seen that could possible guide our decision (none that either of us had seen).  In the end, after applying all of our cumulative knowledge and wisdom and experience to the case, we essentially flipped a coin.

And it feels terrible.  It feels terrible that there is no clear answer to this difficult question, and it feels terrible knowing that we are the ones who are responsible for this decision.  There is no longer an attending who takes responsibility for everything.  We are the attendings now.  And at times it is completely and utterly terrifying.

Sunday, September 13, 2015

Money Stress

I spend far too much time thinking about money.

At work, I keep track of every one of my patient encounters, ostensibly to ensure that I'm correctly billing for my work, but in reality as a way of monitoring exactly how much I'm earning.  When spending money, I record every transaction in my iPhone budget and then check to see how much money is left.  At home, I check my bank account, my monthly budget, and my net worth statement over and over and over again.

It's becoming unhealthy.

On the surface, it seems like the motivation behind this is good - I want to live below my means so that I can be back to a positive net worth by the end of 2016.  Looking deeper, however, it's clear that there are other, less positive, driving forces.  The main one is fear.  I'm afraid that something will happen to me before I'm able to repay my debt and I won't be able to support myself.  I'm afraid that I won't have enough money for retirement.  I'm afraid that I'll always have to watch my spending and will never be able to stop thinking about my budget.

There's also shame.  From the time I was a child, I was a person who saved money.  I saved for my first camera; I saved for university; I saved for my first car.  Prior to starting medical school, my only debt ever had been a small line of credit from my undergraduate degree, which was paid off within a few months of starting graduate school and getting a regular paycheque.  The monstrosity that is my medical school debt (over $210,000 at its worst) looms over me like a reminder of my past sins.  I hate that it's there, and I hate that I'm responsible for how out of control it got by the end.

So.  How do I stop obsessing about money?  The first step is clearly to acknowledge that I am okay.  I'm employed.  I'm earning a good income.  I'm taking steps to save for retirement and repay my debt.  As long as I earn the amount that has been very conservatively estimated for my income*, which I have been from the very beginning, then I can keep my current budget and be out of the red by the end of next year.  I also have a girlfriend with a stable job who would do everything possible to make sure I was okay (we were okay) if something happened.  I am okay.

The second step is to stop thinking about it so bloody much.  While I need to have some awareness of my finances, I don't need to know the precise details on a minute by minute basis.  To this end, I'm restricting how much I can look at my financial information.  Once a day, I can access my spreadsheet of income to enter my billings for the day.  I can look at my iPhone budget only when I'm entering a purchase.  And I can only look at my monthly budget and net worth statement once per week on Sunday mornings when I'm doing paperwork.  No more checking my net worth every few hours to make sure it's still okay.

I'm hoping that stepping back from my finances will make me happier.  My goal, ultimately, is to put my finances on autopilot so that I can focus on the much more interesting business of living this wonderful life that I am blessed to have.

*I'm working fee-for-service, so my income is entirely determined by how much I work.  Which doesn't help with my anxiety.

Monday, September 7, 2015

The Weekly Hiss and Purr - September 7 Edition

I knew from the beginning that I was unlikely to write a "Hiss and Purr" post every week, but I was hoping to do it a bit more frequently than monthly.  By comparison, slukettg at This Liminal Space has been writing her "Weekly Hiss and Purr" literally every week and has lapped me in a very short time.  (If you haven't read her recent post about substance abuse and privilege, you should do that now.  It's way better written and more important than anything I'm going to come up with today.)  I'm going to try to write these posts more often, as they're a relatively easy way to get some of my thoughts out and to keep up with the habit of blogging.  I don't, however, promise weekly.

The Hiss - Insomnia:

Insomnia has been a lifelong enemy of mine, and for some reason it has decided to be particularly bad lately.  Most nights I wake up in the middle of the night to go to the bathroom, and then I lie in bed afterwards for anywhere from one to three hours, completely awake.  On bad nights, the timing of falling back asleep corresponds to the timing of the cats crawling into bed, and then there is no additional sleep for me.  The interrupted sleep has left me profoundly tired - on Friday night, I started whining about needing to go to bed at 9 PM, which is very unusual for a night owl like me.

The strange thing is, I don't know why the insomnia is so bad.  Usually I suffer from insomnia when I'm under stress or unhappy about something, but I don't feel like either of those things are the case right now.  Yes, there is some stress associated with starting work as a real doctor, but it feels very mild compared to what I'd feared.  And I'm not unhappy!  I'm enjoying work even more than I had expected; the girlfriend and I have been doing lots of fun things in our spare time; and I'm getting better about avoiding the trap of staying up too late at night.  I just don't get it!

I've been exercising again recently (more about that later in the week), and I'm hoping that will help turn things around.  Because I'm tired of staring at the ceiling when I should be asleep!

The Purr - Long Weekends:

There is something so unbelievably luxurious about having three days off in a row.  I love having one day for fun things and one day for necessary things and then yet another day for whatever I choose to do.  This has been a particularly good long weekend, as we haven't had any weddings to go to (I am so done with weddings).  I've finished my book (more about Chasing the Scream in a future post), finished knitting my first sock (and started my second), introduced my girlfriend to Treme in honour of the 10-year anniversary of Hurricane Katrina, played board games, tried four different hamburgers for Burger Week, and eaten an amazing celebratory dinner at my favourite tapas restaurant.  And it's not over yet!

At the moment, I'm still in pj's, and I'm keeping my girlfriend company while she makes zucchini loaf.  We have an oldies station playing in the background, and we're chatting about everything from the tragedy of the Syrian refuge crisis to the awkwardness of junior high.  It's everything I need in life.

Wednesday, September 2, 2015

Check In - Home and Hobbies

About a month ago, I wrote a post about my goals for "Home and Hobbies" and promised to check in after starting work to let everyone know how things are going.  Here's the update:

Have two knitting projects on the go at all times:

I've been using knitting as a way of relaxing in the evenings (when I'm not mindlessly surfing the internet), and I've made some good progress on my knitting projects.  I recently finished knitting a baby sweater for a friend, and I just need to sew the hood and sleeves for it to be completely finished.  Her son is now seven months old, so it's a good thing I opted for the 18-month size!  I'm also almost to the end of knitting my first sock, which has been a six-month-long exercise in frustration; I may never knit the second one.

Now that I've finished knitting the baby sweater, I've essentially only got one knitting project on the go, so I need to find something else to work on.  I'm thinking maybe something mindless, like a prayer shawl (maybe a Christmas gift for my Mom?), or something big, like a cozy sweater for myself.  Ravelry here I come!

Cook regularly with my girlfriend:

This one has been fairly successful.  We have a ton of produce from our CSA share (too much zucchini), so we've been doing a lot of cooking in an attempt to avoid wasting the beautiful organic vegetables.  I also finally got our BBQ cleaned off, so we've been eating a lot of charred meat.  I feel a bit like a caveman.

Read for pleasure every day:

This one got off to a very slow start due to exhaustion and my unfortunate technology addiction, but it's starting to pick up.  After starting a few books that didn't hold my interest, I finally found "Chasing the Scream", which is a fascinating book about how the prohibition of drugs has led to the worldwide drug war.  If you have even a passing interest in drug laws or racism or gang violence, you should read this book.

Now that I have a good book, I'm finding some time almost every day for reading.  Unfortunately, I'm approaching the end of this book, so I'm not sure what I'll read next.  Any "must-read" books that you'd suggest?

Keep up with my finances:

I've probably been doing too well with this.  I've continued to track my budget on my iPhone, and I've started tracking all of my billings in an Excel file so that I can confirm that I'm being paid properly for the work I do.  All of the monitoring has made me a bit obsessed with money, and I'm finding that I get unreasonably anxious whenever I spend money or drop below a budget surplus that I've arbitrarily decided is "enough".  I'm hoping that the anxiety will wane as I get a better sense of my income and as I make progress with paying off my debt.

Spend time daily and weekly on keeping the apartment clean and organized:

Remember when I said "This will be a challenge.  A huge challenge."?  I was correct in my assessment.  Cleaning and tidying have been the lowest priorities in my life lately, so the clutter and disorganization are starting to return.  It's been made even worse by the fact that my girlfriend has been going through her own work transition, leaving her with neither the energy nor the motivation to help out much.

We have been doing a few things right, thankfully.  We've been keeping up with the dishes and cleaning the kitchen semi-regularly, which means that there is usually space in the kitchen for cooking and eating.  I've also been doing laundry every Sunday morning, so my laundry pile is small and I always have clothing to wear.  I've also been filing my mail as soon as it comes in, which is keeping me more on top of bills and other important things than I usually am.  So all in all, not a total failure with this goal.

Any goals that you've been working on lately?  How are they going?

Wednesday, August 26, 2015

Evening Routines

OMDG posted today about her challenge with evenings, which got me reflecting on my own evening routine since starting back at work.  When I was on holidays, my plans for my work evenings were very ambitious - cook tasty dinners with my girlfriend, clean the kitchen, take care of housework/paperwork, exercise, and read stimulating and erudite books.  Shockingly, the reality has been somewhat less impressive.  Despite not actually working that hard yet (I'm only working about half-time at the moment), I've been coming home mentally exhausted every day, and I haven't been able to motivate myself to do most of the things I would like to.

Currently, my post-work schedule looks something like this:

1)  Arrive home and dump all possessions (lunch bag, purse, backpack, jacket) in the front hallway.  Ignore voice in the back of my head that tells me that I should be putting things in the spaces I created for them.

2)  Cook dinner with my girlfriend.  This varies from spending 2-3 hours making an elaborate dinner (we love cooking) to BBQing hot dogs and eating potato chips from the bag.

3)  Spend way too much time on the computer.  Facebook, blogs, news, repeat.  I haven't mastered the art of turning off the computer when there is nothing good left to look at, so this eats up a lot of time.  On a good day, I write a blog post of variable quality.

4)  Watch something on Netflix with my girlfriend.  Lately we've been watching Human Planet, which is actually a decent and not entirely mind-numbing show, so it could be worse.

5)  Look at the stack of library books on my coffee table.  Decide it isn't worth the effort.  Possibly watch another Netflix show, usually of lower quality than Human Planet.

6)  Feel progressively more exhausted.  Resist the urge to go to bed like a reasonable human being.  Repeat item #3.

7)  Realize it's past my bedtime.  Rush around trying to make a lunch, pack my work bag, feed the cats, and do anything else that needs to be done.  (Feeding the cats is the only thing I consistently accomplish before bed, and that's only because they meow at me.)

8)  Finally get to bed much later than I should.  Realize that eight hours of restful sleep has become an impossible dream.

9)  Lie awake staring at the ceiling, regretting all of the things I didn't do.

This is something I need to work on, because evenings make up a lot of the quality time I have for myself and my girlfriend outside of work.  Looking back on this time of my life, I don't want Facebook and Netflix and a cluttered apartment to be my most vivid memories.

How happy are you with your evening routine?

Sunday, August 23, 2015

A Post on Parenting by a Childless Woman

One of my good friends from medical school has three children between the ages of 7 months and 5 years.  When it came time for her to go back to residency after her first maternity leave*, she and her husband were faced with the inevitable question of who would take care of the child.  From a financial perspective, it made much more sense for him to stay home, so they decided to go against the societal norm and make him the stay-at-home parent.

Now three children into the process, it seems to be working very well for them.  My friend thrives on her work as a physician and earns enough to support the family, while her husband (mostly) enjoys being the primary caregiver.  Whenever I visit, he is the person that the children go to first, whether for food or comfort or just to whine about one of their many grievances. 

Although the arrangement is mostly good, it does come with its own set of challenges.  While there is a huge network of supports available to mothers from the beginning of pregnancy onwards (exercise classes for pregnant moms, lactation groups, mom-and-baby programs), there is very little for fathers who choose to stay home with their kids.  There's the constant judgement of women who choose not to stay home with their children.  And then there's the never ending societal narrative that says that women should be the caregivers, not men.  It's present in ads for baby products that feature only mothers, in the language we use to describe parenting (e.g. talking about fathers who "help" with the kids or who "babysit" them when the mother is away), and in the way we label restrooms for parents with kids as "Mommy and Me" restrooms.

Even though I don't have children, and probably never will, these things frustrate me to no end.  They frustrate me because they make it unnecessarily hard for fathers to stay home with their children, even when that's what works best for their families.  They frustrate me because they perpetuate the idea that a woman's role is to raise the children, regardless of whether she would prefer to be in the workforce.  And they frustrate me because they limit us to traditional gender roles, even though two X chromosomes don't automatically make a person a better parent than an X and a Y.

We have to start doing better.

*Unlike in the States, Canada has a great parental leave policy that allows the mother and/or father to take a combined total of 50 weeks of partially paid leave.

Friday, August 21, 2015

Doing the Unthinkable

Yesterday afternoon I left work at 1 PM.

This may not sound all that amazing to you, given that people sometimes leave work early for doctors' appointments or other things that need to be done during working hours.  What made it amazing is that I had absolutely nothing to go to.  I was simply done my work for the day*.

As a fellow, I never intentionally came late or left early; it was completely unacceptable to not be at work for the full day.  The few times I was late because of a missed alarm or unexpected traffic, I was inevitably met by a supervisor who would look at his watch and say "Slacking off, are we?"  It didn't matter if I was finished my work for the day or if I could accomplish my work more efficiently in the quiet of my own home:  if it was between the hours of 9 am and 5 PM**, I was expected to be at my desk or in the hospital.

As an attending, on the other hand, I set my own schedule (within certain limits).  I decide when I take call, I decide how many clinics a week I work, and I decide when to do research (if at all).  The freedom is awesome!  And while I have no intention of abusing this freedom, I do intend to make the most of it.  Before starting work, I decided that I will no longer stay at work just to make an appearance.  If I finish my work before 5 PM, I will go home early and enjoy my life outside of the hospital. 

I don't expect this to happen often, and I'm sure there will be days when I make up for it by staying far past 5 PM.  But on the days when I can go home in the early afternoon, I fully intend to do it.  And I intend to enjoy every minute of the kitchen gadget store browsing/cooking with copious amounts of zucchini/napping that I do with my time off.

*Of course, as soon as I left the hospital I got paged to go back, but such is life.

**If you're a resident/physician/other hard-working person who can only dream of a (mostly) 9-5 schedule, I'm sorry.  My chosen career is awesome.